Pelvic pain assessment (Assessment of chronic (long-term) pelvic pain)
An explanation of how long-term pelvic pain in women is assessed, including history, examination and tests, to look for a cause and plan treatment.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A pelvic pain assessment looks for a cause through history, examination and selected tests — not by jumping straight to surgery.
- Pelvic pain often has more than one cause, and sometimes no single cause is found even after thorough assessment.
- An ultrasound is often the first scan; a keyhole operation (laparoscopy) is usually a later step, not a first test.
- Your pain should be taken seriously and a plan made even if scans are normal — a normal test does not mean nothing is wrong.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can identify treatable causes such as infection, endometriosis, cysts or fibroids
A keyhole operation as a first test is usually the wrong step when the examination and ultrasound are normal, because it often finds nothing and carries...
You may have an examination and swabs. An internal examination can be briefly uncomfortable but should not be painful for long; tell the clinician if it...
A clear explanation of what was found and what it means.
You may have an examination and swabs. An internal examination can be briefly uncomfortable but should not be...
You can usually go straight back to normal activities. Some swab or urine results are available quickly.
Scan and other test results come back over this time. You should be told how and when you will get them.
You discuss the results and agree a plan — treatment, referral to another specialist, or, in selected cases, a...
What is a pelvic pain assessment?
A pelvic pain assessment is the careful process of working out why you have pain in your lower tummy or pelvis, usually when it has lasted more than about six months. Long-term pelvic pain is common, affecting around 1 in 6 women.
The assessment is mostly listening and examining, supported by selected tests. Pelvic pain often comes from a combination of causes — for example endometriosis, adenomyosis, period-related pain, bladder or bowel conditions, muscle and nerve pain, or the way pain signals build up over time — rather than one single problem. Stress and past experiences can also affect how pain is felt, which does not make the pain any less real.
The aim is to find treatable causes, rule out anything serious, and build a plan, not to put you through every possible test. Importantly, in a third to a half of keyhole operations done to look for a cause, nothing abnormal is found, so an operation is not always the right first step.
This guide explains what the assessment usually involves. It does not replace a personal discussion with your clinician.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Ultrasound vs laparoscopy for pelvic pain
| Test | What it is | When it is used |
|---|---|---|
| Transvaginal ultrasound | An internal scan, no anaesthetic | Usually the first scan |
| MRI | A detailed scan, no anaesthetic | To look closer at suspected causes |
| Diagnostic laparoscopy | Keyhole surgery, general anaesthetic | A later step when surgery is justified |
A keyhole operation carries surgical risks and is normal in a third to a half of cases, so it is not a routine first test.
Preparing for your test
- Keep a pain diary noting when pain happens, how bad it is, and any link to periods, sex, the bladder or bowel.
- Note what makes the pain better or worse, and which treatments you have already tried.
- Write down questions and what you most want from the appointment (an explanation, a plan, or both).
- Bring a list of your medicines and any allergies.
- Be ready for the possibility of an internal examination; you can ask for a chaperone or decline on the day.
- Bring details of any previous scans, operations or results if you have them.
- Think about who you would like to bring for support, if anyone.
What happens
Most of the assessment happens in a clinic. The clinician will spend time asking about your pain and how it affects your life, your periods, your bladder and bowel, your sexual health and your mood, because all of these can be involved.
They will usually examine your tummy and, with your consent, do an internal examination to feel for tenderness or masses and to see whether the examination reproduces your pain. Swabs and a urine test may be taken to check for infection.
A transvaginal ultrasound is often arranged as the first scan, and an MRI is sometimes added. Based on what is found, the clinician will explain the likely cause or causes and suggest a plan — which might be treatment, referral to another specialist (such as a bowel, bladder, pain or physiotherapy service), or, in selected cases, a keyhole operation. A good assessment ends with a clear next step, even when the cause is not yet certain.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A keyhole operation as a first test is usually the wrong step when the examination and ultrasound are normal, because it often finds nothing and carries surgical risk.
- A gynaecology assessment alone may be the wrong route if the pain is clearly coming from the bowel, bladder, muscles or nerves — those services may be needed instead or as well.
- Repeating the same normal test is not helpful when symptoms have not changed.
- Sudden severe pain, suspected ectopic pregnancy or signs of serious infection need urgent care, not a routine clinic assessment.
Delay or rearrange if…
- You have an active infection that should be treated and reviewed first.
- There is a chance of pregnancy that needs excluding before some tests.
- Symptoms are changing rapidly or you are acutely unwell — urgent assessment comes first.
- Key previous results or scans are missing and would change the plan.
Alternatives to discuss
- A trial of treatment (for example for suspected endometriosis or period pain) before further tests
- Referral to bowel, bladder, pain or physiotherapy services if the cause points that way
- Watchful waiting with a clear safety net if symptoms are mild and not alarming
- Psychological support or pain-management programmes for long-term pain
- A second opinion if you feel your pain is being dismissed
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Can identify treatable causes such as infection, endometriosis, cysts or fibroids
- Helps rule out conditions that need urgent attention
- Gives an explanation and a plan, even when no single cause is found
- Can avoid an unnecessary operation by using examination and scans first
- Can bring in the right specialists (bladder, bowel, pain or physiotherapy) when needed
Risks & complications
- Discomfort or embarrassment during an internal examination
- Not getting a clear single diagnosis, which can feel frustrating
- Needing more than one appointment or test before there is a plan
- Tests such as scans being normal even though the pain is real
- An incidental finding on a scan that needs further tests but may not be the cause of the pain
- Being passed between services if no single cause is found
- A test pointing to a cause that later turns out not to explain all the pain
- Complications from a later keyhole operation, if one is done (covered in its own guide)
- A serious cause being found that needs urgent treatment
The biggest issue with pelvic pain is being dismissed or, at the other extreme, being put through an operation too quickly. A careful assessment tries to avoid both. It is normal not to find a single cause, and that should lead to a plan to manage the pain — not to being told there is nothing wrong. Ask your clinician what they think is causing the pain, what the tests can and cannot show, and what the plan is if the tests are normal.
Published figures to discuss
Pelvic pain assessment is about information, not a procedure, so there are no meaningful 'success' or complication percentages for the assessment itself. The honest figures relate to what is found: long-term pelvic pain affects around 1 in 6 women, and in a third to a half of keyhole operations done to investigate it, no obvious cause is found. This is why examination and scans usually come before surgery, and why a normal result does not mean the pain is not real.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| No cause found at diagnostic laparoscopy | Around a third to a half of cases | A normal keyhole operation is common and is one reason it is not used as a routine first test. | Guide sourcesClinical context |
| Endometriosis missed on ultrasound | Possible, especially superficial peritoneal disease | A normal scan does not rule out endometriosis; specialist ultrasound is better for deep disease and endometriomas. | Guide sourcesClinical context |
| Pelvic pain having more than one driver | Common | Endometriosis, pelvic floor muscle pain, bladder pain, IBS, adhesions, nerve pain and trauma can overlap. | NHS — Endometriosisnhs.ukSource-linked context |
| Serious cause behind new pelvic pain | Uncommon but important | Postmenopausal bleeding, weight loss, fever, pregnancy, severe sudden pain or a mass needs urgent assessment. | NHS — Endometriosisnhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is usually no physical recovery from the assessment itself. The main thing is waiting for any test results and then agreeing a plan.
- Some soreness or spotting after an internal examination or swabs
- Waiting a little while for scan results
- Not having a complete answer after the first appointment
- Needing follow-up to put the pieces together
Aftercare
- Keep your pain diary going, as it helps the clinician judge whether treatments are working.
- Make sure you know how and when you will get any test results.
- Take any treatment for infection or pain exactly as prescribed.
- Go back if the pain gets suddenly worse, or new symptoms appear.
- Ask for a clear plan if scans are normal, rather than accepting that nothing can be done.
- Attend any onward referrals (bladder, bowel, pain or physiotherapy services) arranged for you.
- Look after sleep, gentle activity and stress, which can all affect long-term pain.
- A pain diary to bring to the appointment and updates afterwards
- A list of questions about likely causes and the plan
- A note of previous scans, operations and results
- A list of medicines and allergies
- A way to record when and how you will get results
- Support from someone you trust if you would like it
⚠ Get urgent help if…
- Sudden, severe pelvic or tummy pain, especially with feeling faint
- Heavy vaginal bleeding, or any chance of pregnancy with pain (possible ectopic pregnancy — seek urgent help)
- Fever, feeling very unwell, or smelly vaginal discharge (possible infection)
- Pain with vomiting, a swollen tummy or being unable to open your bowels
- Blood in the urine or stool, or unexplained weight loss
- New pain after the menopause, or bleeding after the menopause
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good assessment ends with either a likely cause and a treatment plan, or a clear explanation that no single cause has been found together with a plan to manage the pain. Both are valid outcomes. Normal scans are common and do not mean the pain is imagined — many causes of pelvic pain cannot be seen on a scan.
What an assessment cannot do is guarantee a single, simple answer, or promise that treatment will remove the pain completely. The goal is to understand the pain well enough to reduce it and improve your life, and to keep reviewing the plan.
Findings from an assessment remain useful for planning, but pelvic pain can change over time, so the plan may need reviewing. If symptoms change or new ones appear, it is reasonable to be reassessed rather than assuming an earlier result still explains everything. Scans may be repeated if the picture changes.
Related tests, treatments or support
Pelvic pain assessment often runs alongside other tests and services, because the cause may involve the bowel (for example irritable bowel syndrome), the bladder (such as interstitial cystitis), muscles and nerves, or mood. Bringing in bowel, bladder, pain or physiotherapy specialists is common and is a sign of thorough care, not of being passed around.
Follow-up & long-term care
After the assessment, you should be told your results, given a plan, and offered follow-up to see whether treatments help. If a keyhole operation is being considered, it should be discussed as a specific decision with its own risks and benefits. Long-term pelvic pain usually needs ongoing review rather than a single visit.
Repeat, follow-on and what comes next
- It is common to need more than one appointment or test before there is a clear plan.
- Scans may be repeated if symptoms change over time.
- The diagnosis may be revised as more information emerges or as you see how treatments help.
- Being referred on to another specialist is normal and not a sign of being dismissed.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of what was found and what it means.
- A written or clearly communicated plan, even when no single cause is found.
- A named contact and a way to get results and ask questions.
- Appropriate onward referrals (bowel, bladder, pain or physiotherapy) when needed.
- Planned review to see whether treatments are helping, and to adjust the plan.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The type of clinician you see and the length of the appointment
- Swabs, urine and blood tests for infection and other causes
- Scans such as transvaginal ultrasound or MRI, and who reports them
- Follow-up appointments to discuss results and plan treatment
- Whether referral to other specialists (bowel, bladder, pain or physiotherapy) is needed
- Whether a keyhole operation is later chosen (this has its own, larger cost)
- The consultation fee and who you will see
- The cost of swabs, urine and blood tests
- The cost of any scans (ultrasound, MRI) and who reports them
- Follow-up appointments to discuss results
- What happens, and what it would cost, if a keyhole operation is needed
- What happens if the tests are inconclusive or no single cause is found
- The cancellation policy
On the NHS? Pelvic pain is commonly assessed on the NHS through your GP and gynaecology services; private care is often used for a quicker appointment, a scan, or a second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being told the pain is 'all in your head' rather than being given a plan when tests are normal.
- Being offered a keyhole operation without explaining that it often finds nothing and carries risk.
- An internal examination done without clear consent, explanation or the offer of a chaperone.
- No clear plan for who gives you results, and what happens if they are normal.
Marketing red flags
- Promising to find the cause of all pelvic pain with one scan or one operation.
- Offering surgery quickly as the main answer for long-term pain.
- Claiming a single treatment cures all pelvic pain.
- Downplaying the role of the bowel, bladder, muscles, nerves and mood in long-term pain.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What do you think is causing my pain, and could there be more than one cause?
- Which tests are you arranging, and what can they and can't they show?
- What is the plan if the tests come back normal?
- Would treatment be worth trying before considering an operation?
- Should any other specialist (bowel, bladder, pain or physiotherapy) be involved?
- How and when will I get my results, and when will we review the plan?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will I definitely get a diagnosis?
Do I need a keyhole operation to find the cause?
What does a normal scan mean?
Will I have an internal examination?
Could the pain be linked to my bowel, bladder or stress?
Can I be assessed on the NHS?
Find a verified specialist for pelvic pain assessment
Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.
No verified consultants list this procedure yet — browse the full directory.
How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: RCOG — Long-term pelvic pain RCOG — Initial management of chronic pelvic pain (Green-top Guideline 41) NHS — Endometriosis NHS — Pelvic inflammatory disease NHS — Adenomyosis
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Adenomyosis treatment · Heavy periods (heavy menstrual bleeding) treatment · Hysterectomy (womb removal) · Antenatal care and pregnancy scans · Cervical screening (smear test)